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We included RCTs of adults (18\u201365\u2009years, BMI\u2009\u2265\u200925\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) without major comorbidities, except for type 2 diabetes, testing GLP\u20101 RAs, structured exercise, or both. Of 2508 screened articles, nine studies comprising 1009 participants met eligibility criteria. Participants included 589F\/420M, with a weighted mean age of 43.8\u2009\u00b1\u200912.2\u2009years and weighted mean BMI of 32.6\u2009\u00b1\u20093.0\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Risk of bias was assessed using RoB 2. A frequentist random\u2010effects model calculated SMDs. Primary outcomes were changes in body weight, waist\u2010to\u2010hip ratio, and fat mass. Secondary outcomes included fasting glucose, HOMA\u2010IR, triglycerides, LDL\u2010C, and HDL\u2010\n                      <jats:styled-content style=\"fixed-case\">C. Meta<\/jats:styled-content>\n                      \u2010regression assessed weight loss as a predictor of metabolic outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The combination of GLP\u20101 receptor agonists and exercise was associated with the greatest effects on weight (SMD \u22121.04; 95% CI \u22121.24 to \u22120.83), fat mass (SMD \u22121.01; 95% CI \u22121.27 to \u22120.75), and waist\u2010to\u2010hip ratio (SMD \u22120.55; 95% CI \u22120.91 to \u22120.18) compared with placebo. For fasting glucose, the SMD was \u22120.49 (95% CI \u22121.52 to 0.55); for HOMA\u2010IR, \u22120.59 (95% CI \u22120.89 to \u22120.29). For lipid outcomes, no statistically significant differences were observed for triglycerides or LDL\u2010C, whereas HDL\u2010C increased compared with placebo (SMD 0.32; 95% CI 0.04 to 0.61). Confidence in the evidence was high for body weight and fat mass, moderate for waist\u2010to\u2010height ratio and most lipid outcomes, and very low for fasting glucose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Combined GLP\u20101 RA and structured exercise interventions improved weight, insulin sensitivity, and selected lipid parameters more than monotherapies or placebo.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/obr.70189","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:53:56Z","timestamp":1784004836000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative Efficacy of GLP\u20101 Receptor Agonists, Exercise, and Their Combination on Body Composition and Glucolipid Metabolism in Adults With Overweight or Obesity: A Network Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1111","volume":"27","author":[{"given":"Matteo","family":"Vandoni","sequence":"first","affiliation":[{"name":"Laboratory of Adapted Motor Activity (LAMA) \u2010 Department of Public Health, Experimental Medicine and Forensic Science University of Pavia  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6628-7938","authenticated-orcid":false,"given":"Alessandro","family":"Gatti","sequence":"additional","affiliation":[{"name":"Laboratory of Adapted Motor Activity (LAMA) \u2010 Department of Public Health, Experimental Medicine and Forensic Science University of Pavia  Pavia Italy"},{"name":"National PhD Programme in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine University of Pavia  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Rossi","sequence":"additional","affiliation":[{"name":"Pediatric Department \u201cVittore Buzzi\u201d Children's Hospital  Milan Italy"},{"name":"Department of Biomedical and Clinical Science University of Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4829-1447","authenticated-orcid":false,"given":"Matteo","family":"Giuriato","sequence":"additional","affiliation":[{"name":"Department of Education and Sport Sciences Pegaso University  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittoria\u00a0Carnevale","family":"Pellino","sequence":"additional","affiliation":[{"name":"Department of Education and Sport Sciences Pegaso University  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianvincenzo","family":"Zuccotti","sequence":"additional","affiliation":[{"name":"Pediatric 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